Motivational Incentives to Reduce Secondhand Smoke in NICU Infants' Homes

减少 NICU 婴儿家中二手烟的激励措施

基本信息

批准号：
8619654
负责人：
Angela L Stotts
金额：
$ 62.32万
依托单位：
UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-03-09 至 2017-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8619654
关键词：
Admission activity Adverse effects Affect Air Asthma Behavior Therapy Behavioral Belief Biological Assay Caring Cessation of life Child Child health care Childhood Chronic Cigarette Clinic Clinical Investigator Communities Cotinine Coughing Counseling Data Economically Deprived Population Ensure Environmental Tobacco Smoke Exhibits Extremely Low Birth Weight Infant Family Fathers General Population Growth Health Healthcare Home environment Hospitalization Hospitals Hour Household Incentives Infant Infant Health Intervention Interview Investigation Life Logistic Regressions Low Birth Weight Infant Low income Lung Malignant Childhood Neoplasm Measures Mediating Mediator of activation protein Medical Minority Modeling Monitor Mothers Motivation Neonatal Intensive Care Units Neurocognitive Deficit Nicotine Outcome Parents Population Poverty Preparation Prevalence Preventive Quality of life Race Randomized Recruitment Activity Relative (related person)Reporting Research Research Infrastructure Resources Respiratory Tract Infections Risk Services Severities Smoke Smoker Smoking Smoking Behavior Specific qualifier value Subgroup Sudden infant death syndrome Testing Time TimeLine Tobacco Validation Very Low Birth Weight Infant Visit Wheezing Writing base cost design ear infection effective intervention experience health care service utilization health disparity high risk high risk behavior high risk infant high risk parents improved infant morbidity/mortality innovation intervention program meetings member middle ear disorder motivational enhancement therapy multidisciplinary post intervention programs pulmonary function respiratory smoking cessation smoking prevalence social success tobacco exposure young adult

项目摘要

DESCRIPTION (provided by applicant): Chronic secondhand smoke exposure (SHSe) in children compromises pulmonary function and contributes to respiratory illness, wheeze, cough, asthma, middle ear disease, and sudden infant death syndrome. Preterm, low birth weight infants admitted to a Neonatal Intensive Care Unit (NICU) are especially vulnerable to the effects of SHSe, with many exhibiting significant respiratory or chronic lung conditions prior to discharge. Because smoking remains concentrated in less educated and impoverished communities, NICU families with household smokers are at significant risk for tobacco-related health disparities--a substantial burden to families with limited resources and the communities in which they reside. The primary aim of this investigation is to evaluate the efficacy of a hospital initiated, behavioral intervention to reduce household SHSe, compared to conventional care practices, in low-income, multi-ethnic parents of NICU infants at particularly high social and medical risk for adverse effects of SHSe. A randomized, controlled, parallel group design will be used to test whether a SHSe program initiated in the hospital and completed in the home using motivational interviewing plus motivational incentives (MI+) is more effective than Conventional Care (CC) with NICU parents. The effects of MI+ versus CC on household smoking and infant smoke exposure are expected to be mediated via motivation to change and treatment participation. A total of 396 families with an infant at high respiratory risk in the NICU who report a household smoker will be randomized. The MI+ intervention will consist of 4 one-hour counseling sessions (2 in the hospital; 2 in the home post-discharge) and incentives for both session attendance and establishing a home smoking ban. CC will involve written materials that include information about the effects of smoking and cessation tips discussed in meetings with a Family Life Coordinator. Counseling and interviews will be conducted in Spanish and English. Primary efficacy variables will include objective and valid measures of SHSe (infant cotinine, household air nicotine monitors, Timeline Followback for SHSe). Outcomes will be assessed at 1 and 6 months post-intervention using generalized linear mixed models, poisson and logistic regression. This will be the first study of an innovative combination of motivational strategies targeting SHSe within the context of a NICU to improve the health of vulnerable infants and their families, potentially saving millions in healthcare dollars. This trial may also demonstrate a practical means of accessing young, minority and economically disadvantaged families for preventive services, who are unlikely to present to traditional clinics for such care. Highly experienced behavioral and clinical investigators, pilot data suggesting intervention feasibility and promise, a large and accessible population, and an extraordinary infrastructure ensure study success.

描述（由申请人提供）：儿童中的慢性二手烟暴露（SHSE）损害了肺功能，并导致呼吸道疾病，喘息，咳嗽，咳嗽，哮喘，中耳病和猝死综合症。早产，接受新生儿重症监护病房（NICU）的低出生体重婴儿特别容易受到SHSE的影响，许多婴儿在出院前表现出明显的呼吸道或慢性肺部状况。由于吸烟仍然集中在受过良好教育和贫困的社区中，因此有家庭吸烟者的NICU家庭面临与烟草有关的健康差异的巨大风险，这对资源有限的家庭及其居住的社区这一重大负担。这项调查的主要目的是评估与常规护理惯例相比，在低收入的NICU婴儿的传统护理习惯中，降低家庭股东的行为干预措施的疗效，对SHSE不良影响的社会和医疗风险特别高。随机，受控的，平行的小组设计将用于测试是否在医院启动并使用动机访谈加动机激励措施（MI+）在家庭中完成的SHSE计划比与NICU父母的常规护理（CC）更有效。预计MI+与CC对家庭吸烟和婴儿烟雾暴露的影响将通过改变和治疗参与的动机来介导。 NICU中总共有396个患有高呼吸风险的家庭，他们报告了家庭吸烟者。 MI+干预措施将包括4个一小时的咨询会议（医院2次；在家庭后收取后2个）和两次会议上课和建立家庭吸烟禁令的激励措施。 CC将涉及书面材料，其中包括有关与家庭生活协调员会议讨论的吸烟和戒烟技巧的信息。咨询和访谈将以西班牙语和英语进行。初级疗效变量将包括SHSE的客观和有效度量（婴儿Cotinine，家用空气尼古丁监测器，SHSE的时间表后卫）。结局将在干预后1个月和6个月进行使用，使用广义线性混合模型，泊松和逻辑回归。这将是针对NICU的动机策略的创新组合的首次研究，以改善弱势婴儿及其家人的健康，从而节省了数百万美元的医疗保健资金。该试验还可能证明是一种实用的手段，即可获得年轻，少数民族和经济弱势家庭的预防服务，他们不太可能向传统诊所提供这种护理。经验丰富的行为和临床研究人员，试点数据表明可行性和承诺，大量且可访问的人群以及非凡的基础设施确保了研究的成功。